Facility Evaluation Report

Licensing Program Analyst (LPA) Victoria Brown arrived unannounced on 11/6/24 at 12:20PM to conduct a Required - 1 Year inspection visit. LPA met with Clifford G. Tejada Jr., Administrator, and explained the purpose of the visit. Licensing fees are current. The Administrator certificate for Clifford G. Tejada expires 6/3/25.

The facility is licensed for a capacity of 6 residents. LPA observed residents are at day program during this visit. LPA toured and inspected the physical plant inside and outside to ensure there are no safety hazards to residents. LPA observed a Designation of Facility Responsibility (LIC308). LPA observed the most recent emergency drill was conducted on 10/12/24.

LPA observed kitchen, dining area, bedrooms and bathrooms, storage areas, laundry and lighting throughout the facility. LPA observed supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days maintained on the premises.

LPA observed the facility handles P & I monies and there is no commingling of the monies which are logged and accounted for during this visit. Facility has a Infection Control Plan on file. The temperature inside the facility was observed to be at 72*F which is within the required range of 68-85*F. The hot water temperature was measured at 105.6*F which is within the required range of 105-120*F.

LPA observed a pull alarm system, fire extinguisher(s), smoke and carbon monoxide detectors, and central heating and air in the facility.

LPA observed the centrally stored medications area to be locked and inaccessible to residents.

The first aid kit contained the required items such as sterile dressings, bandages, adhesive tape, scissors, tweezers, thermometers, antiseptic solution and guide.